An athlete requires more food for fuel than the average person, but deciding what to eat is a greater problem for the diabetic, especially when he's selecting from carbohydrates, the food group with the most powerful effect on blood sugar. Traditional wisdom once held that a simple carbohydrate, like the sugar in ice cream, drives blood sugar up with a quick jolt and should be avoided, except in low blood-sugar emergencies. But recent research shows that simple carbohydrates don't affect the blood sugar as much when eaten along with a meal. Also, some complex carbohydrates, like carrots and white potatoes, raise blood sugar faster than ice cream or even candy bars.
To compensate for the lowering of blood sugar that exercise causes in diabetic athletes, insulin should be decreased or food increased before competition. Besides their mealtime intake, athletes eat carbohydrates during and after competition—usually 10 to 30 grams per hour, depending on how much they exert themselves and how much they've cut back on their insulin doses. And they also keep reliably fast-acting carbohydrates, like glucose tablets, on hand to stave off low blood-sugar emergencies of the kind Santo experienced.
In trying to balance insulin and food intake, diabetic athletes are forever bedeviled by complications. Their bodies work harder and burn more sugar in both extremely hot and cold weather. Women's blood-sugar levels can fall greatly during pregnancy or menstrual periods.
Some athletes get by with few difficulties, but others have to fight an endless battle. One of the unfortunates is Lye. "I carry so much food along," says Lye, "that the guys claim I've got a deli in my bag. One day I had breakfast, then a big lunch, then a Gatorade before teeing off, then three hot dogs, four Cokes and three candy bars in the first 12 holes. The rest of the way I stopped at snack shops.
"That may sound like fun, but believe me, it isn't. Not when you're standing over a putt, so dizzy you could pass out, and you need 10 minutes to recover, no matter what you eat."
Almost every diabetic athlete can recall at least one low blood-sugar emergency. Triathlete Bill Carlson had his crisis during a 100-mile bike ride along a lonely stretch of the Pacific Coast Highway outside Los Angeles.
"It was 7 a.m. and chilly," he recalls. "My reserves of sugared liquid were gone, and I was fading fast. I was just getting desperate enough to break the window of a grocery store when I was saved by a group of French tourists with a cooler of Cokes in their trunk."
It is easier these days for diabetic athletes to avoid such incidents; urinalysis is being replaced with more convenient and accurate tests utilizing instruments called glucometers. Even during competition, perhaps at halftime or between innings, an athlete can prick his finger, put a drop of blood on a chemically treated strip and insert the strip into a hand-held meter to get an exact readout of his blood-sugar level.
For the vigilant diabetic with no vascular problems, exercise is not only safe, but probably beneficial. According to Dr. Ralph DeFronzo, a diabetologist at Yale University, "Diabetics are extremely susceptible to severe vascular problems like blindness, kidney disease, gangrene and heart disease. Although there's little hard evidence, it makes sense to assume that aerobic exercise, which improves circulation, will at least retard the onset of these diseases."
Almost every well-known diabetic athlete has publicly endorsed the benefits of exercise and has lectured other diabetics on how to compete safely in sports. This is a far cry from the not-too-distant past, when many doctors discouraged diabetics from taking part in sports, and the diabetics who competed feared that revealing the disease would jeopardize their careers.